Don't Fear the Tracheostomy

Speaker0:
[0:15] Hi, everyone. I'm Emily.

Speaker1:
[0:18] And this is Eva.

Speaker0:
[0:19] And you're listening to Speech Talk.

Speaker1:
[0:21] We're your research book club so you can do evidence-based practice in practice.

Speaker0:
[0:25] So let's start talking. Eva, how are you? Tell me all about it.

Speaker1:
[0:31] I was really hoping to ask you first because I feel like I can't think of anything that happened this week that was, like, work-related. I'm like, I know I went to work. I did go. I clocked in and then, oh, I did fit testing this week. Have you ever done fit testing?

Speaker0:
[0:53] Yeah, for your N95?

Speaker1:
[0:55] Yeah. And so if you don't know what this is, basically you're trying to find out, are you wearing your N95 appropriately? Like, is it actually preventing anything from getting in? And the way they test this is they have you put on the N95 appropriately, then they put a large bag over your head and they spray an odorless but terrible tasting drink. A solution into the bag. And if you can taste it, then you fail. But in order to make sure you know what it tastes like, they have you inhale it through your mouth beforehand. And so I'm just standing there doing the testing as he's like counting off the segments and we're all like bending over and turning our heads left and right to try and like loosen the mask to assess whether or not it's properly sealed. So just like a room of people nodding, shaking, bowing, only breathing through their mouths and everyone faintly tasting this disgusting acrid flavor.

Speaker0:
[1:56] With bags on your head.

Speaker1:
[1:57] With bags on our heads. I was like, this is super weird if you're watching from the window.

Speaker0:
[2:03] I know. We did that too, except your company is mean. There's a sweet flavored one. Why are they making you do the bitter one my company actually said like there's a sweet one and a bitter one but we wouldn't do that to you.

Speaker1:
[2:21] I didn't know there was an option

Speaker0:
[2:24] I remember when i did that too they had us doing like all these like physical exertion things and i was like can i not do the jumping jacks it makes me pee my pants, like latent uh having baby problems later my yeah my.

Speaker1:
[2:39] Pelvic floor is not what it once was

Speaker0:
[2:42] Uh that's funny.

Speaker1:
[2:43] Okay and how about you emily what you've been up to

Speaker0:
[2:45] I got back from vacation so i still feel like i'm on vacation and i just don't care to be at work, so i'm just like have been going through the motions i called um one of our mutual friends and i was like, girl just sucks It just sucks. And she goes, you know what? Sometimes when I feel like that, it's because I've lost creativity. And I was like, shut up. You're right. But like...

Speaker0:
[3:11] It's a hard realization when you're like, yeah, that's an introspective problem.

Speaker1:
[3:15] Okay, and before we start this week's episode, we're trying something new. Here are some quick headlines from the SLP research world. One, dysphagia may now be the primary indicator of malnutrition in head and neck cancer from the oral oncology report. Also, being able to measure a patient's circumlocution may help as a diagnostic factor for very mild aphasia, also known as VMA, as if we need another acronym to learn. And finally, a study published in Digital Signal Processing discussed how a new AI approach helped computers more accurately recognize people with dysarthria, which is so helpful. I mean, think about all the times we use like voice authentication for our phones or our bank accounts and people with dysarthria really struggle with things like that. So way to go, folks. Way to keep researching.

Speaker0:
[4:09] Yeah, sounds like one of those, at least one of those could be an episode.

Speaker1:
[4:12] Yeah, seriously. We'll circle back to one of those. All right, Emily, get us started. What are we doing?

Speaker0:
[4:18] So this week, Eva, when you hear someone say trach patient, what is the first thing that comes to your mind clinically?

Speaker1:
[4:30] Oh, God. Oh, God, no. I'm so sorry if you or a loved one has a trach. I just, as a clinician who has genuinely not had a lot of opportunities to do trach work, and I know that this is a medically very fragile population, I'm like, oh no, somebody hold my hand. I need more guidance is my overall emotional reaction. And then I remember random words like cuff and deflate and cannula. And that's about it.

Speaker0:
[5:06] Those are all very awesome words.

Speaker1:
[5:09] I did go to school. I know some words.

Speaker0:
[5:12] When it comes to trachs, I think you did hit a lot of what makes people very nervous. And I think the major or one of the most prevalent being that you're just medically fragile when you have a trach. So I keep saying that word trach. What is a trach? A tracheostomy is a tube that connects your airway or moves your airway from your mouth and nose to a hole in your neck. And that's significant because there's not typically a hole in your neck. And that makes a lot of things that we deal with as speech therapists difficult, like eating and talking.

Speaker1:
[5:53] Yeah. And specifically, that hole goes into your airway. So we have this additional orifice to your airway, which, by the way, you got to figure out how to keep stuff out of it, you know, because things are not supposed to be getting into your lungs. And then also on the back end, when you're swallowing, now we have this other like complicating factor of, well, there's more than one way in and out these days.

Speaker0:
[6:20] Yes. And this is one of the more technical areas for us speech therapists. Whether you're dealing with this for adults or children, these patients are pretty medically fragile and need a lot of extra care and attention. And we have to be on our P's and Q's when we're dealing with tracheostomy tubes and the patients who have them.

Speaker1:
[6:45] Yeah. And I'll say, thank gosh, not a ton of people need trachs. And that's why they are such a small subset of our clinical caseload. But the result is that it's really hard to get exposure and like good clinical training. So, yeah, I do think that there's a lot of reasons that relatively new clinicians or clinicians who just haven't had a lot of opportunities for them to be nervous.

Speaker0:
[7:10] Right. And a lot of times if someone does have a trach, they are going to a specialized facility that houses many people who have trachs and they have respiratory therapists on staff. And not all skilled nursing homes offer this. So I have talked about my previous experience with trachs, but I wanted to just go a little bit further into our role in the tracheostomy care this week.

Speaker1:
[7:36] All right. BRB, you guys, we're going to check some cuff pressures and dream of sponsorships.

Speaker0:
[7:47] So the research this week. We are discussing speech pathology services are integral but underutilized in tracheostomy rehabilitation by Stephanie Davis, Ashley Way, Salem O. Salomon, and all.

Speaker1:
[8:02] Yeah, so their basic premise was this. SLPs are underutilized in tracheostomy care, despite the fact that we are really valuable. We do a lot of respiratory work, we do feeding work, we do communication work, which are all affected with a tracheostomy. So they reviewed about 255 tracheostomy patients and found that 23% never received an SLP evaluation. Only about 34% got a speaking valve and about 53% got a swallow study. Patients who did receive SLP services had consistently better decannulation rates and the authors recommend earlier routine SLP involvement. All that is to say is like before we really get into the nitty gritty, if I didn't already enough, is that the authors are basically like, like if we can get earlier routine SLP involvement, that would be great and create a clinical workflow to standardize that pathway from sorry, the pathway specifically from tracheostomy to decannulation.

Speaker0:
[9:02] They cited that over 100,000 patients receive a tracheostomy each year, and those people receiving tracheostomy are because of prolonged mechanical ventilation, trauma, and upper airway obstruction.

Speaker1:
[9:17] Yeah, which I think just jumps back to what we were saying earlier about fragile populations. Like if you have a tracheostomy, something intense happened. Like this is not the only thing going on.

Speaker0:
[9:28] The study in general, it was a retrospective study, which means they were digging through all of these old charts to find information so that we already know that there can be errors and limitations. So we're just going to keep this mindful while we're going through this. They're just going through old notes. They couldn't change or fix anything. They were just looking at what had happened.

Speaker1:
[9:50] Admittedly, I love a retrospective study. I think that there is so much to be done with just the documents we already have. And congrats to people who are working on clinical intervention research. But there is so much documentation about how patients were treated, what their plans of care were. And it's just like this, I don't know, like it's like an orchard of research material. Start picking charts off of trees.

Speaker0:
[10:18] It makes you feel better that like maybe someday somebody will actually read your notes.

Speaker1:
[10:26] That would be incredible. And some of those are embarrassing.

Speaker0:
[10:30] I was tired that day.

Speaker1:
[10:33] Yeah. Some days I go back, I read my notes. I'm like, wow, that is not my best clinical writing.

Speaker0:
[10:40] So one of the things they wanted to see was 100% SLP evaluation after tracheostomy. But where did they actually land? At about 77%. But the SLP getting the call like six to eight days post-op.

Speaker1:
[11:00] That like first period, the six to seven days after post-op is kind of mind-boggling to me because in my mind, I'm thinking about all the patients I get who have been intubated. Like they had something traumatic happen and they had to, you know, force the airway. And I'm like, those people are put NPO. Like, I don't know, I guess part of maybe my shock is that I don't actually know what the transition to, you know, getting put back on food is after you have a tracheostomy. But I'm just imagining people being on an NPO diet for like six to eight days and maybe that's not accurate. But I'm just like, oh, wow, no one's doing like a swallow study after they put in the trach for like a week. That's crazy.

Speaker0:
[11:52] I will say that, like, that was surprising to me, too. Normally, when I see somebody who has a trach, that is one of the first thing, that I'm looking for. But they do, a lot of the patients who come to the skilled nursing, they have a PEG tube. Like though in the hospital, they're medically fragile. Maybe they get an NG tube for the short term, but as they stay on the NG tube, that doesn't last very long. And then they'll get the PEG tube in the meantime. But even so, NPO, your oral cavity quickly dries up. You'll be surprised how many like thick, like boogers I pulled off of the inside of people's mouths because they got put on NPO and just forgotten about. And that is terrible. It's always the worst thing to see.

Speaker1:
[12:45] Yeah, that's, that is really terrible. And I think one of the difficult things for us, like tell me from your experience, when you're getting people who are trached and they have a peg tube, did they have a swallow study done when they came to you? Like, did they have one in their chart?

Speaker0:
[13:02] I, it's, uh, a lot of times it depends on the person or the circumstances, um, how alert somebody is. I've gotten people who, um, when I'm evaluating, I'm using the Glasgow coma scale, right? To see if they're even responsive to me, if they're able to respond to cues or anything like that, all the way to somebody who is very fluently having conversations with me. But I will say, even though that is the spectrum of people that I've seen at evaluation, it's also been a spectrum of people who have had swallow studies done. I think it's, in my experience, it's been very quick that if somebody has a trach, then their MPO, their NPO for a few days, they got to have a peg tube.

Speaker0:
[13:51] And for me, I've never recommended anyone having a peg tube in my career. I'm sure a lot of acute care SLPs are very comfortable, like MPO, got to get a peg. And it's easy, but that's... That area kind of scares me. So that was surprising to me too, that six to eight days. It was funny in that article too, they said that the least likely group to get an SLP eval was the upper airway obstruction, which was ironically funny to me because that's like our whole niche is like the upper airway. So like if they like choked or something, if something happened to the pharynx that required them to have tracheostomy, then they're like, nah, we don't need those speech therapists what would they know.

Speaker1:
[14:43] You know what that's a really good point i didn't think about that at all but like the potential like sub-demographic that we would be most relevant towards are like no least likely to get an slp eval i wonder why

Speaker0:
[14:56] As retrospective we'll never know.

Speaker1:
[14:59] We'll never know we can never go ask and ask those people

Speaker0:
[15:01] About 33 of the population evaluated was cleared for a speaking valve and And then about half of the subjects had a swallow eval, and 75% of the swallow evals performed were bedside. Eva, what?

Speaker1:
[15:14] Wait. Three quarters of the swallow evals were only bedside swallows? Oh, no. Okay, if you don't know what that means, it's that, so an instrumental swallow study is where they actually have you eat either in front of an x-ray machine or with a nose, a camera looking into your throat. So you were actually seeing the swallow. A bedside is where we just give you some food and we watch you and we listen to you and we're like, hmm, I think it's fine. And the idea that three quarters of the subjects were given an I think it's fine style evaluation when they had a tracheostomy blows my mind.

Speaker0:
[16:00] It is highly surprising because the biggest thing about tracheostomy is when it comes to those swallowy valves is that with the opening of your neck to with that airway, you're not getting air from your mouth and your nose down into your lungs. You're missing a big sensory component when it comes to swallowing and you're not feeling things the same way. You're not tasting things the same way. You don't have that pressure differential that a normal healthy swallow has when all of the tubes and pumps and areas are closed like they should be.

Speaker1:
[16:43] Sorry, I'm just imagining like an anatomy and physiology class and they're like, okay, this picture of someone's respiratory tract, tubes and pumps, you guys, just tubes and pumps, that's it.

Speaker0:
[16:55] That'll be the next meme is tubes and pumps.

Speaker1:
[16:57] This is the large tube, this is the small tube, the big pump, the medium-sized pump. You guys are going to do fine.

Speaker0:
[17:04] There's like all of these systems working together. So when there's something that creates that opening that ruins that pumping and closed system, what we see is a whole lot of silent aspiration that people are aspirating and we don't see it. So if we're only doing bedside evaluations for people who have an already pretty compromised airway, that's bad. bad that's bad bad.

Speaker1:
[17:35] I i don't that's pretty bad

Speaker0:
[17:38] I don't condone but.

Speaker1:
[17:40] Retrospective we're just sitting here we're just looking back we're just sitting here looking at the papers and being like who made what decisions

Speaker0:
[17:49] We look back at it so we can make better decisions in the future.

Speaker1:
[17:53] No in history man don't repeat it um so a majority of the subjects were eventually decannulated 62% during the follow-up period. SLB services were utilized more in subjects with a longer duration of tracheostomy dependence, and there was consistent improvement in downsize and decannulation rates in like all of the cohorts of all of the groups. So what are some of those terms? Well, tracheostomy dependence is like, were you reliant on the tracheostomy for a while? And then the downsize and decannulation. So decannulation is when we are able to take out that tube from your throat. Is that right, Emily? Did I get that right? Okay. In our super technical language that we're using here today, that tube in the hole in your airway that was made by a surgeon and not by God, we took it out.

Speaker0:
[18:49] So what makes someone a bad versus a good candidate for decannulation?

Speaker1:
[18:55] Let me see. If I were to guess a bad candidate for decannulation, oh, I was going to guess somebody who has bad cognition because we love to talk about the intersection with cognition. But I'm like, I don't know, maybe they're not a good candidate in the first place because if they like don't know what it's about, then maybe they're trying to take it out. So is it cognition?

Speaker0:
[19:18] Cognition was not listed, but I do like that. The two that they put down was having pneumonia and being unable to manage your secretions. So if you're getting mucus built up in your lungs, you're not able to cough that up through your mouth. You're needing suctioning through your tracheostoma hole that's in your neck. Tracheostomy is the contraption that's in your neck. On the flip side, what would make someone a good candidate for decannulation?

Speaker1:
[19:51] They, I don't know, demonstrate like independent management or they, oh, wait, you said that they can't manage your secretion. So maybe these people have a good cough or like good secretion management.

Speaker0:
[20:04] Snaps for Eva. Yes. Adequate cough. They're able to clear those secretions. Another good positive indicator that their tracheostomy tube has been previously downsized. So maybe they started from a larger hole and they're healing tolerance of an occlusive cap. So that is where the tracheostomy is still present. But instead of breathing through the tracheostomy, having that open, they put like a cover on it. So then your airway is able to go back up through your nose and mouth. And that cover is just acting like your skin would normally. And then finally, maintenance of oxygen levels of 90% or more for 24 hours on room air. So we're not using any other types of devices to help you breathe.

Speaker1:
[20:58] Yeah. Just in general, PSA, if your oxygen is below 90, go get help right now. Stop listening to this podcast. If you're like oxygenating below 90 and go seek medical attention.

Speaker0:
[21:11] Thank you. That's funny that you, like you said, 90, because it's like, well, I'll bring out my pulse ox and it's 80. If anybody's below 86, then you stopped reading like that. So we got a little bit of wiggle room here.

Speaker1:
[21:26] Um i will say that on like the decannulation predictors um some other things that were higher odds of decannulation were like uh head and neck cancer trauma and uh successful swallow studies like if those things are present then you are have higher odds and lower odds of getting decannulation are obesity and prior tracheostomy history actually the reason that head and neck cancer has a higher decannulation rate is because a lot of times the tracheostomy is actually elective so they put it in beforehand like as a preventative measure kind of like sometimes they put in a peg tube before someone starts treatment so that they're kind of already set up. We don't have to be potentially engaging in these things after they've undergone cancer treatment.

Speaker0:
[22:19] I wonder where that brings us back to the involvement of a speech therapist in those cases.

Speaker1:
[22:25] So the way I read it was that a lot of times these patients, they're decannulated way more quickly, like the four to five days. So they didn't really feel that clinicians were, SLP clinicians were necessarily urgent. I don't know that I necessarily agree with that because Because to me, I'm like, you still did an invasive procedure that changed someone's airway, albeit temporarily. You can't just guarantee that it's going to work 100%. All surgeries have risk of complications. Every time you cut somebody open and put something in them and then take it back out, I think we should just cautiously be... Assessing the situation and hoping that it's fine and we don't need further intervention, but just like, why don't we do a video fluoroscopy study, you know, just real quick. Right.

Speaker0:
[23:16] I mean, if they have the head and neck cancer diagnosis, then I'm sure it's not just that that we could be evaluating and doing. So that pulls back into, I guess, the underutilization of the speech therapist in the case. I'm assuming.

Speaker1:
[23:33] Yeah.

Speaker0:
[23:34] It's retrospective.

Speaker1:
[23:35] Particularly because like when we think about those cancer patients, what they're saying is that the tracheostomy was preemptive, right? So we're just going to take it out. But again, these are head and neck cancer patients. They could have been having parts of their tongue removed, parts of their pharynx removed, like critical pieces of like muscle groups and organs that are... Related to eating and swallowing. So I think that the authors touched on this, that this is kind of a red flag that the lack of SLP was more related to, oh, this is like a cut and dry tracheostomy procedure, ignoring, on the other hand, the head and neck cancer aspect of it.

Speaker0:
[24:18] The other thing I thought they said in the article was interesting. So frequent, late, or often missed consults to SLP were causing frequent delays in the rehabilitation and decannulation process. So they said, additionally, there were regular urgent consults placed to SLP and the surgical airway teams on the day of discharge, to give evaluations and guidance about decannulation where rehabilitation potential is limited to time constraints.

Speaker1:
[24:51] I love that. They're like, really quick, before we send this patient home or to skilled nursing, there's like a critical airway problem. Can you just like jump down here and give us your advice?

Speaker0:
[25:02] It's so crazy because there's so many things that you want to look at when it comes to someone who has a tracheostomy. Are we looking at voice? Are we looking at swallowing? Like, what is the goals here? Yeah.

Speaker1:
[25:18] Yeah.

Speaker0:
[25:18] And how can we help? Like the day of discharge, I would be livid. I would.

Speaker1:
[25:24] Look, man, the number of things that happen day of discharges will always blow my mind. But I think in terms of like other seemingly counterintuitive findings, they also said that patients who received speaking valves actually had longer tracheostomy durations, but higher decannulation rates. And This is maybe because SLPs were called in on these harder cases. So it's kind of like underselling the impact of SLPs in a way.

Speaker0:
[25:54] Yeah, definitely underselling. I think in some of those cases, maybe it takes the speaking, like the speaking valve may take longer. I mean, it's always dependent on the person, but maybe it takes longer because you're being cautious about how quickly you're upgrading these people. Every speech therapist is very different in their practice. And some speech therapists are like, yeah, you look good. We did this for 30 minutes. Now keep it on all waking hours. And other people are like, let's do an hour. Let's do three. And it just, that rehabilitation timeline could just be medical reasons, the speech therapist, but I mean, we'll honestly never know, but, having someone there in case something goes wrong is always going to be better than nothing.

Speaker1:
[26:44] Yeah, definitely.

Speaker0:
[26:46] So how do we apply the research? What should a skilled nursing SLP know when receiving a patient with a tracheostomy?

Speaker1:
[26:56] Well, definitely have they had a swallow study.

Speaker0:
[26:59] Yeah, review the chart.

Speaker1:
[27:01] Let's find that out. We want to know why they got trached because that is really informative in our plan of care development. Like head and neck cancer versus motor vehicle accident is going to be different in our approach.

Speaker0:
[27:15] You're exactly right. We need to know what happened in the situation to have someone on a tracheostomy tube. But when you're preparing to go into that evaluation, the things that I always look to want to know is I want to know the size of the trach. Is it like how big is the trach itself? I want to know what kind of air they're on. Are they on a mechanical ventilator? Are they on room air? Are they breathing through nasal cannula? What is the trach like? Is it like a constantly cuffed trach? Is it, they have some that are like foam almost that are a little bit more malleable. I want to know their diet. I want to know if they came on a peg tube or not.

Speaker1:
[28:03] Yeah. And I would also say, like, if we're trying to get, in terms of the overall plan of care development, if we're trying to get a sense of are they going to be ready for decannulation, we can refer to some of what we talked about earlier, like use that checklist that they came up with, which I think they said has like a 93% positive predictive value. So it's a pretty good checklist. Was the tube downsized, just like you said? Can they clear secretions with coughing? Can they tolerate that occlusive cap, that sort of lid on the tracheostomy? And are they saturating at 90% oxygen on room air for like 24 hours? Yeah. If when you're looking at your plan of care for your patient and they're saying, hey, can I do this? You can tell that to the doctor and be like, hey, they've met these four checklist items. I think it's time that we start looking at their overall plan of care in terms of decannulation.

Speaker0:
[29:01] Yeah, really good short-term goals for those. If you are receiving a patient, with a tracheostomy, what might be some red flags that would make you push for an additional assessment? it.

Speaker1:
[29:14] Sorry, wait, one second. It just occurred to me. Your initial question was, what should SNF SLPs know when receiving a patient with a trach? And my gut reaction was still like, everything, where's my health? Mom, hold my hand. And I'm so sorry for if any of you thought that that's what this episode was going to be. And it wasn't. I'm really sorry we weren't here to re-explain all of trait care to you. I hope one day to be that competent of a clinician, like circle back in a year and we'll find out if I've improved at all.

Speaker0:
[29:49] Oh, you will.

Speaker1:
[29:52] I don't know. I don't get a lot of trach patients. It's still a great mystery to me.

Speaker0:
[29:55] You're not getting a lot of trach patients at the hospital?

Speaker1:
[29:58] I have not had a single trach patient since I've been to the hospital.

Speaker0:
[30:04] Wild.

Speaker1:
[30:05] Wild. I know. Again, it's just crazy how different caseloads can be. But anyways, going back to your red flags that would make you push for an additional assessment, probably one that not being able to clear your own secretions. If they're not coughing stuff up, then we have some serious concerns about airway compromise overall.

Speaker0:
[30:26] So that actually probably wouldn't be a red flag to me because... No? No, because with the airway being opened, if they're not clearing secretions, they just suction.

Speaker1:
[30:38] Oh, that's a really good point. That's a really good point. But I don't know. I think I still want to see maybe an instrumental, no?

Speaker0:
[30:46] And if we're ready for food, if like that is the next thing.

Speaker1:
[30:53] Oh, I see what you're saying. Yeah, yeah, yeah. Okay. If we're working to get off of an NPO or like a no food order.

Speaker0:
[31:00] So if red flags, I might say if somebody is seemingly constantly fighting an infection, like I would want to see if something was, going wrong with their airway. If for some reason they're using their passing mirror and they cannot voice, I would be curious to see about a fees to see if there was any damage to their vocal folds.

Speaker1:
[31:27] Okay.

Speaker0:
[31:28] If we're like, if we're starting to, yeah, starting to do food or starting to do liquids and you just notice a rush of fluid coming from the trachea, that's a huge red flag. Like, stop.

Speaker1:
[31:41] And how would you say that we can start, like, as the article says, advocating for earlier drugs? SLP involvement for our trach patients?

Speaker0:
[31:52] I always feel like education is going to be where it's at. You might feel like you're blue in the face, but if you are, with the doctors, if you're with your staff and you are showing them, look, these are the things that we are able to do, and you come with articles like these handy and say, we can be more involved in these cases. And if you are, God forbid, the SLP who is getting those trach referrals on day of discharge, take these articles and just mass print, put them all over whoever office it is who is not giving you the referrals and tell them that, you know, you are valuable in the care of these patients and you deserve to have a voice and a spot and a seat at the table.

Speaker1:
[32:43] Yeah. And if I can kind of reflect what you're saying, it's not just that we should be involved. It's that we shouldn't just be the emergency call, like that discharge day consult. No, we should be there advising. And even if our advice is, nope, this patient is clear, like we don't need to be involved any further, great. But That's an important data point that that patient is safe. And we needed to have verified that. And because the answer could be the converse. The answer could be, wow, there is like some severe airway compromise, even with the tracheostomy. You know, we're seeing some big issues with this person's management of their secretions. We want to be here helping them plan through that. And also for the speaking valve. Aren't we the talking people? I don't understand.

Speaker0:
[33:37] I know. And it comes to the use of the speaking valve. I'm not sure, like, I probably should have Googled this before the episode, but who is all qualified to be, like, handing them out? But, I mean, we're included in that list. So if it's just that people are going from trach to being capped because there's not that intermediary area where we would step in and give those devices or provide that education that it's an opportunity missed.

Speaker1:
[34:10] Yeah so get involved as early as possible understand the decannulation workflow and like what that checklist is and really make an effort to be a part of the team because your insight is valuable, even if it means going back to your textbooks and rereading everything you used to know about Drake's. I promise you can still be helpful.

Speaker0:
[34:34] And if you really don't know where to start, Passy Mirror has really great free CEUs for you to watch and get refreshers.

Speaker1:
[34:47] Can I do that like right now?

Speaker0:
[34:49] All right, guys. When in doubt, dig into the research We'll be here for you

Speaker0:
[34:54] when you do More evidence.

Speaker1:
[34:55] More questions Feels accurate at this point for me Today

Speaker0:
[35:01] You've been listening to Speech Talk.

Speaker1:
[35:03] Thank you, everyone, for coming to listen to our research book club. Until next time, keep learning and leading with research.

Speaker0:
[35:09] If you like this episode and you want to give us some love, please rate us on your favorite podcasting app. Leave a review and tell the world, because as podcasters, our love language is in positive affirmations.

Speaker1:
[35:21] And if you like listening to us, you may like more podcasts from our network, Human Content, like how to be patient, bendy bodies, knock knock high with the glock and fleckens, and psychiatry bootcamp. If you have a research topic you want us to cover, or you have episode comments, clinical experience you want to share, or just want to send us some love letters, send us an email at hello at speechtalkpod.com.

Speaker0:
[35:45] If you want even more speech talk content, check out our website at speechtalkpod.com, where you can find all of our resources we made for you, copies of articles covered, and Eva's blog following these topics and more.

Speaker1:
[35:58] We're your hosts, Eva Johnson and Emily Brady.

Speaker0:
[36:01] Our editor and engineer is Andrew Sims.

Speaker1:
[36:03] Our music is by Omar Ben-Zvi.

Speaker0:
[36:06] Our executive producers are Aaron Corney, Rob Goldman, and Shanti Brooke.

Speaker1:
[36:10] To learn about Speech Talk's program disclaimer and ethics policy, verification and licensing terms, and HIPAA release terms, you can go to speechtalkpod.com slash disclaimers.

Speaker0:
[36:22] Speech Talk is a proud member of the Human Content Podcast Network.